RESUMO
OBJECTIVES: The utilization of barbed sutures in laparoscopic hysterectomy has become popular among gynecologic sur-geons. Our aim was to compare the outcomes of two different techniques for closing the vaginal cuff with barbed sutures in laparoscopic hysterectomies. MATERIAL AND METHODS: A retrospective study was completed on 202 patients who underwent laparoscopic hysterectomy for benign diseases at Istanbul Kanuni Sultan Suleyman Training and Research Hospital from April 2014 through June 2016. In group 1 (n = 139), a single-layer continuous suturing method was used; each bite contained the pubocervical fascia and vaginal mucosa anteriorly, and vaginal mucosa and rectovaginal fascia posteriorly. In group 2 (n = 63), a double-layer continuous suturing method was used; only vaginal mucosa was included in the first layer, and a second layer incorporated the pubocervical and rectovaginal fascias. RESULTS: Patient characteristics (age, body mass index, parity, previous abdominal surgery, smoking, comorbidity) were similar between the two groups. There were also no differences in total operation time, length of hospitalization, intraop-erative complications, and perioperative change in hemoglobin levels. There was no difference between the two groups in terms of vaginal cuff dehiscence, which was the primary outcome measure of the study. Secondary outcome measures (presence of granulation tissue, spotting, cuff cellulitis) were also similar between the two groups. CONCLUSIONS: We observed no differences in outcomes between single- or double-layer vaginal closure techniques with barbed sutures.
Assuntos
Histerectomia/métodos , Laparoscopia/métodos , Técnicas de Sutura/estatística & dados numéricos , Vagina/cirurgia , Adulto , Feminino , Humanos , Histerectomia/instrumentação , Laparoscopia/instrumentação , Pessoa de Meia-Idade , Estudos Retrospectivos , Suturas , Resultado do Tratamento , TurquiaRESUMO
AIMS: To determine and compare the effectiveness, peri- and postoperative outcomes of mid-urethral sling (MUS) operations for urinary incontinence, using 2 different patient positions during surgery. METHODS: In this study, 146 patients underwent MUS surgery in a urogynecology clinic. Of them, 72 patients underwent the intraoperative surgical procedure of reverse trendelenburg patient positioning for tape adjustment (group 1) and the remaining 74 patients had the routine surgical procedure of MUS surgery (group 2). The primary outcome was the evaluation of postoperative urine leaks, using the stress test, and secondary outcomes were quality of life, using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF, Turkish version) and complication rates. RESULTS: There were no significant differences in demographic variables between the 2 groups. The overall cure rates for incontinence in the lithotomy position was 97.22 and 85.13% for groups 1 and 2, respectively, in which group 1 had a statistically significant decrease in urine leak postoperatively (p < 0.05; OR 3.08, 95% CI 2.78-22.14). The postoperative ICQ-SF scores showed no significant difference between the 2 groups (p = 0.19). CONCLUSION: Applying a 45-degree reverse trendelenburg position for tape adjusting during MUS operation results in a greater objective cure rate compared with the typical dorsolithotomy position; however, there was no difference in the subjective outcome.
Assuntos
Postura , Slings Suburetrais , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Feminino , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/cirurgiaRESUMO
AIM: The aim of this study is to determine the risk factors of mesh exposures following abdominal sacral colpopexy (ASC) in which polypropylene mesh is used. METHODS: This is a retrospective cohort study of patients who underwent ASC and were subsequently followed for development of mesh exposure for vaginal/vault prolapse between 2002 and 2012. Demographics and risk factors of the patients who did develop mesh exposure after ASC and the ones who did not were compared. RESULTS: In 42 months of survey, 19 of the 292 patients who underwent ASC developed mesh exposure. It was found that rates of patients with stage 3-4 prolapse were significantly greater in the mesh exposure group than in the control group (P = 0.04). Rates of mesh exposure were lower in patients with previous hysterectomy (P = 0.03). Also, it was found that concomitant hysterectomy or three or more additional procedures increased the risk of mesh exposure (P = 0.03 and P = 0.02). CONCLUSION: In abdominal sacrocolpopexy operations in which polypropylene meshes are used, stage 3 or 4 prolapse, concomitant hysterectomy and three or more additional procedures increase the risk of mesh exposure development.
Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Idoso , Estudos de Coortes , Feminino , Humanos , Histerectomia , Modelos Logísticos , Pessoa de Meia-Idade , Polipropilenos , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: The aim of this study was to evaluate the clinical characteristics, peri- and post-operative outcomes, and clinical effectiveness of the Manchester-Fothergill (MF) procedure for uterine descensus as a uterine-sparing surgery. METHODS: In this study, 49 patients underwent the MF procedure as a uterine-sparing surgery for uterine descensus during 2008-2012 in the Department of Urogynecology at Kanuni Sultan Süleyman Research and Teaching Hospital, Istanbul, Turkey. RESULTS: Medical records and follow-up data were collected from 24 of the 49 patients (48.9 %). The mean age was 49.3 ± 9.1 years, and parity 3.6 ± 1.5; 41.6 % were post-menopausal; 6 patients (25 %) had grade II, and 18 (75 %) had grade III uterine prolapse; 95.8 % had associated cystoceles, and 79.1 % had associated rectoceles; 66.6 % complained of urinary incontinence. On follow-up examination, the cervical stumps were satisfactorily situated in 23 of 24 patients, and recurrent prolapse was seen in 1 patient (4.1 %). Bladder perforation was repaired at the time of the operation in 1 patient, and one complained of post-operative urinary retention. CONCLUSION: The MF procedure is a viable option to surgically correct uterine descent while preserving the uterus to treat recurrent prolapse with a low complication rate and low morbidity.
Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso Uterino/cirurgia , Adulto , Idoso , Cistocele/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Retocele/cirurgia , Resultado do Tratamento , Turquia , Doenças da Bexiga Urinária/cirurgia , Incontinência Urinária/cirurgiaRESUMO
OBJECTIVE: To evaluate the success rate of Bakri balloon tamponade (BBT) for managing postpartum hemorrhage (PPH), intractable to conservative medical treatment, as a fertility sparing intervention. MATERIALS AND METHODS: We evaluated 47 women treated with BBT who had severe postpartum hemorrhage and uncontrollable bleeding due to failed treatment with uterotonic agents. The main outcome measure was successful management and preservation of the uterus. RESULTS: Forty-seven women were identified for BBT treatment due to severe PPH. BBT was used to successfully manage hemorrhage in 43 patients, and there was no need for hysterectomy. Four patients required an additional surgical procedure. Of the four failures, a subtotal hysterectomy was performed in two patients, and the other two patients underwent a total hysterectomy. The overall success rate was 91.4%, which was comparable to rates reported earlier. The main cause of PPH was uterine atony (43%). CONCLUSION: Uterine preservation is an important issue when managing PPH. BBT is an effective, easy to use, and safe procedure for massive PPH that can minimize recourse to hysterectomy after failed medical treatment.
Assuntos
Preservação da Fertilidade , Hemorragia Pós-Parto/terapia , Tamponamento com Balão Uterino , Adolescente , Adulto , Cesárea , Feminino , Preservação da Fertilidade/métodos , Humanos , Histerectomia , Trabalho de Parto Induzido , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/cirurgia , Gravidez , Retratamento , Estudos Retrospectivos , Falha de Tratamento , Adulto JovemRESUMO
The aim of this study was to evaluate the effect of an electromagnetic field (EMF), generated close to the ovaries, on primordial follicles. A total of 16 rats were used in this study. The study group consisted of rats exposed to an EMF in the abdominal region for 15 min/d for 15 days. Both the study and control group were composed of eight rats. After the treatment period of 15 days, the ovaries of the rats were extracted, and sections of ovarian tissue were taken for histological evaluation. The independent samples t test was used to compare the two groups. In the study group, the means of the right and left ovarian follicle numbers were 34.00 ± 10.20 and 36.00 ± 10.53, respectively. The average total ovarian follicle number was 70.00 ± 19.03. In the control group, the means of the right and left ovarian follicle numbers were 78.50 ± 25.98 and 71.75 ± 29.66, respectively, and the average total ovarian follicle number was 150.25 ± 49.53. The comparisons of the means of the right and left ovarian follicle numbers and the means of the total ovarian follicle numbers between the study and control groups indicated that the study group had significantly fewer follicles (p < 0.001, p = 0.011, and p = 0.002, respectively). This study found a significant decrease in the number of ovarian follicles in rats exposed to an EMF. Further clinical studies are needed to reveal the effects of EMFs on ovarian reserve and infertility.
Assuntos
Campos Eletromagnéticos , Folículo Ovariano/fisiologia , Animais , Feminino , Folículo Ovariano/citologia , Ratos WistarRESUMO
AIM: The aim of this study was to determine the relationship between serum concentrations of cancer antigen-125 (CA-125) and pre-eclampsia severity. METHODS: We evaluated 91 females with a singleton pregnancy. Serum CA-125 levels were measured in subjects with severe pre-eclampsia (n=34) and those with mild pre-eclampsia (n=24). Females with healthy pregnancies (n=31) served as the control group. The three study groups were statistically similar in terms of maternal age, gestational age, and body mass index. RESULTS: The CA-125 level was significantly higher in the severe pre-eclampsia group than that in the mild pre-eclampsia and control groups (p<0.05). No significant difference in CA-125 levels between the mild pre-eclampsia and control groups was observed. CA-125 level was positively correlated with proteinuria (r=0.489, p=0.000), systolic blood pressure (r=0.503, p=0.018), and diastolic blood pressure (r=0.532, p=0.000). In contrast, CA-125 was negatively correlated with birth weight (r=0.266, p=0.012) and gestational age at birth (r=0.250, p=0.018). CONCLUSIONS: CA-125 level increased in severe pre-eclampsia, which reflected abnormal trophoblastic invasion and chronic inflammation. Elevated levels of CA-125 in pre-eclamptic patients may be a marker of the disease severity.